Lee said:
<<BTW, someone quoted a study by Riordan that was in the JHL. Jan Riordan
spoke at a conference a few years ago and mentioned one of her studies (I'm
not sure if it is the same one). The conclusions showed no negative effect
of epidurals on breastfeeding.>>
That's odd. Her 2000 study indicated that it took longer for a couplet to
establish effective breastfeeding (using the IBFAT score) than if a woman
didn't have an epidural. I asked her if she looked at the length of time the
epidural was in place or if she looked at the number of boluses the mother had
and she said she hadn't. But maybe we are looking at two different things.
FWIW, when I left the birthing center in MI and moved to IL, I started
working as a clinician at a hospital in the Chicagoland area in 1982. At that
time, mothers were laboring in semi-private labor rooms, and most of them either
got a pudendal block or a paracervical block for the delivery. There were
no epidurals then. If they had to have an "Emergency" C/Section (all
C/Sections that weren't otherwise scheduled) then she got a general.
I've been at that same hospital now for 24 years, (in varying capacities)
including as the IBCLC for a pediatric practice at that hospital for nearly 18
years. We've moved from semi private labor rooms to lovely LDRs. We no
longer use generals for C/SEctions (praise God), but use spinals. We no longer
use paracervicals or pudendals. Our episiotomy rate has dropped dramatically
-- and our epidural rate has risen even more dramatically. I think we run
about a 85 - 90% epidural rate of the moms that delivery vaginally. Make that
about 95%.
Babies are left with mothers a lot more than they were in 1982. Babies are
breastfeeding in the LDR at a much much higher percentage rate than they were
in 1982 --
Induction rates have skyrocketed over the past 24 years.
So, what have I seen in regards to breastfeeding? It's a heck of a lot more
difficult. More mothers are having a harder time getting babies to latch.
Nearly every primip needs lactation help, and a lot of the multips. I'm
seeing far more moms after they go home from the hospital with latch issues than
I was in 1990 -- and a lot more moms where milk seems to be slower to "come
in" than in 1990.
All of this, of course, is a lot different than the Family Birthing Center
in which breastfeeding problems were virtually a non-issue. But as someone
said, that milieu is completely different - much as the home birth is completely
different.
It seems that the longer I'm there, the higher the epidural rate, the harder
it is to get babies latched.
That's personal experience talking, that's not Evidence Based Practice.
One anecdote -- when I take a history, I always ask the mom if she had
medication or an epidural during labor. One dad was in the room when the mom was
answering the question -- "an epidural, yes." Dad jumped in and said, "Oh,
but we made sure she didn't have any Fentanyl." I just said, "Oh, OK" --
found out later he's an anesthesiologist.....
Perhaps they DO know something about the effect of the epidural meds on the
baby....
(\__/)
(='.'=)
(")_(") Jan Barger, RN, MA, IBCLC
_Lactation Education Consultants_
(http://www.lactationeducationconsultants.com/)
_My Mother of the Bride Blog_ (http://www.motherofbridebyjan.blogspot.com/)
_Torrey's Blog_ (http://www.marriedcouplebytorrey.blogspot.com/)
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